Healthcare Provider Details

I. General information

NPI: 1295043875
Provider Name (Legal Business Name): ALLINA HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 CHICAGO AVE MAIL ROUTE 10017
MINNEAPOLIS MN
55407-1321
US

IV. Provider business mailing address

480 OSBORNE ROAD NE SUITE 200
FRIDLEY MN
55432
US

V. Phone/Fax

Practice location:
  • Phone: 612-262-4828
  • Fax: 612-262-3755
Mailing address:
  • Phone: 763-236-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number347114
License Number StateMN

VIII. Authorized Official

Name: JOHN STOLTENBERG
Title or Position: VP MEDICAL AFFAIRS
Credential:
Phone: 763-236-3769